Endometriosis Treatments

By Dr Ananya Mandal, MD

There is no cure for endometriosis. In most patients, the condition resolves with menopause, as the hormone (estrogen) that influences the growth of endometrial tissue declines and the tissue begins to shrink and ultimately resolve. During the reproductive years, the aim of treatment is to provide relief from symptoms such as pain and heavy bleeding and to correct or treat infertility.

The treatment options for endometriosis include:

Surgical removal of the lesions can be performed and is one of the best treatment options for women suffering from associated infertility. For women with severe symptoms or who are approaching menopause, removal of the uterus and the lesions may also be considered.

Different degrees of surgery may be performed depending on assessment of the ovary during the procedure. Surgery may be:

Conservative, where the endometriotic lesions are removed, excised or undergo ablation with special instruments

Semi-conservative, where the ovaries are allowed to continue functioning

Radical, with the removal of both the ovaries as well as the uterus

Non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac may be used to ease pain and reduce inflammation.

In women who do not wish to become pregnant, hormonal medications may be useful. Some of these include:

Progesterone-containing medications that counteract the effects of estrogen and prevent growth of the endometrial lesions. Menstruation can be reduced or eliminated using progesterone pills or injections. This helps relieve the symptoms of endometriosis. Examples of these drugs include medroxyprogesterone acetate, dydrogesterone and norethisterone.

Oral contraceptive pills are a combination of estrogen and progesterone and help relieve the pain and heavy bleeding associated with menstruation.

Danazol and gestrinone are steroids with androgenic actions and are also called antiprogestins. These drugs can prevent the growth of endometriosis. However, they can also cause side effects such as the growth of facial hair and other symptoms of masculinisation

Gonadotropin releasing hormone (GnRH) agonist leads to feedback inhibition and reduction in the secretion of estrogen. Examples used to treat endometriosis include buserelin, goserelin and leuprolin.

Aromatase inhibitors such as anastrozole and letrozole prevent the formation of estrogen.

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